A 54-year-old man comes to his GP for a diabetes check-up. He has a past medical history of type 2 diabetes and is currently on one diabetes medication (500mg metformin BD). He reports no adverse effects from this treatment. His most recent retinopathy screening was unremarkable. You draw blood to assess his HbA1c levels.
What is the recommended target HbA1c for this patient?
A 42-year-old woman presented with complaints of constant fatigue and underwent blood tests. All results were within normal limits except for her thyroid function test (TFT) which revealed:
TSH 12.5 mU/l
Free T4 7.5 pmol/l
What would be the most suitable course of action?
A 54-year-old man with a history of hypertension comes in for a check-up. During his annual health assessment, he undergoes a U&E, HbA1c, and cholesterol test. The results are as follows:
His blood pressure today is 128/78 mmHg. He takes ramipril 5mg od as his only regular medication.
Na+ 142 mmol/l
K+ 4.6 mmol/l
Urea 5.2 mmol/l
Creatinine 88 µmol/l
Total cholesterol 5.2 mmol/l
HbA1c 45 mmol/mol (6.3%)
His 10-year QRISK2 score is 7%. What is the most appropriate course of action based on these findings?
A 35-year-old woman has been referred by her doctor for thyrotoxicosis treatment. After discussing the available options, she chooses to undergo radioiodine therapy. What is the most probable side effect of this treatment?
As the on-call FY2 covering the wards, you are asked to assess a 55-year-old woman who was admitted yesterday with community-acquired left basal pneumonia. Over the past 12 hours, she has deteriorated significantly with a temperature of 40.5ºC, blood pressure 160/95 mmHg, and heart rate of 130 bpm. On examination, she appears jaundiced, agitated, and confused. Her medical history includes hayfever and Graves’ disease, but she has been generally healthy otherwise. What is the most important initial treatment to start for this patient, given the likely diagnosis?
A 27-year-old female patient complains of tremors and excessive sweating. Upon conducting thyroid function tests, the results are as follows:
TSH <0.05 mU/l
Free T4 25 pmol/l
What is the leading cause of this clinical presentation?
A 70-year-old man with a history of hypothyroidism is admitted to the Emergency Department after experiencing chest pain. He is diagnosed with acute coronary syndrome and iron-deficiency anemia. A percutaneous coronary intervention is performed, and a coronary artery stent is inserted. Endoscopies of the upper and lower gastrointestinal tract are performed and reported as normal. Upon discharge, he is prescribed aspirin, clopidogrel, ramipril, lansoprazole, simvastatin, and ferrous sulfate in addition to his regular levothyroxine. Six weeks later, he reports feeling constantly fatigued to his GP, who orders routine blood tests. The results show a TSH level of 8.2 mu/l, which is elevated compared to the patient’s previous two years of TSH levels within range. Which of the newly prescribed drugs is most likely responsible for the raised TSH?
A 35-year-old woman has recently undergone blood monitoring for hypothyroidism. She is currently on a 100 micrograms dose of levothyroxine and her last blood tests showed normal levels of thyroid-stimulating hormone (TSH) and free thyroxine (ft4). However, her TSH has now risen to 8mU/L with ft4 slightly below the reference range. The patient confirms that she has been taking her levothyroxine as prescribed. You decide to review her recent medications to identify any potential causes for the suboptimal hypothyroidism treatment. What new medication could be responsible for this?
Which of the following outcomes confirms a diagnosis of diabetes mellitus?
You are performing the yearly evaluation of a 42-year-old woman with type 1 diabetes mellitus. Your objective is to screen for diabetic neuropathy that may affect her feet. What is the most suitable screening test to utilize?